PBS aired a compelling story about midwives learning to do cesarean surgery to fill the shortage of doctors in rural Mozambique.

The young midwife featured is shown conducting a couple of repeat cesareans. One for a placental abruption for which uncontrolled bleeding leads to a hysterectomy. Another mother is given a repeat cesarean and she is clearly unhappy about. The supervising doctor/teacher tells the midwife to be kind to the mother, give her special treatment, that way when she is pregnant again she will come to the hospital at 8 months and they can schedule her next cesarean. The implication is to avoid a ruptured uterus. He wants her to have the opportunity for more children in a culture where 2 children are not considered enough.
Yet, when he leaves her to do the surgery to attend to other patients, the midwife is shown deciding for herself – while the mother sleeps under anesthesia – to sterilize the mother.

Whew. Interviewing the midwife later, it is clear that she doesn’t have up to date information about the safety of vaginal birth after cesarean (VBAC). Also, it is clear that she really thinks she did this woman and her family a favor. She talks about missing her mother who died when she was 20.

Going to the PBS website, a short video shows American Certified Nurse Midwives working in the hospital environment. One midwife asks a woman, in for her first prenatal exam, if she wants a vaginal birth this time. The mother says she certainly does, she doesn’t want a cesarean again.

What we work hard to gain or to hold on to here is already being eradicated as the physiology of birth is bypassed to spread obstetrics. It makes sense to take advantage of the African midwives’ intelligence and add another life saving skill to her abilities. But what a loss to never teach a midwife midwifery.